Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS

Community Health Issues Faced by Health Departments John Melech, RN, Sean Haase, RN, Sara Walker, RN Missouri State University

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS Community Health Issues Faced by Health Departments What is a Health Department? According to the Merriam Webster dictionary (2012), a health department is a division of local or larger government responsible for the oversight and

care of matters relating to public health. Health departments focus on issues related to the general health of the public such as epidemiology, vaccinations, communicable disease reporting, various health testing such as STI testing, strep testing and cholesterol testing. Health departments also coordinate community health fairs. Various health departments house community health inspectors and womens health services such as WIC (Women, Infants, and Children) programs and breast feeding education programs. The health departments also participate in the referral process to refer certain individuals to certain community programs such as education programs for health promotion, prevention, and maintenance. How do community health departments address the concept of health across the lifespan? According to the World Health Organization (WHO) (2012), health is defined as a state of complete physical, mental, and social well-being, and not merely the absence of disease. Health departments keep this in mind when providing services to the public. Community health departments see a wide variety of people of all ages with many different health disparities as well as healthy people participating in preventative measures. They provide a variety of basic health services to the public such as health education, health screenings, vaccinations, blood pressure checks, blood testing, and participate in the community referral process. Individuals throughout the lifespan go to the health department for these different services. Infants and Children According to the Centers for Disease Control and Prevention (CDC) (2012), the United States infant mortality rate is 5.98 deaths per 1000 live births. According to the CDC, leading

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS

causes for infant mortality in the United States are birth defects, prematurity, and maternal illness during pregnancy. All of these causes partly stem from prenatal issues such as low folic acid intake, maternal smoking and drug use, and lack of prenatal care. In an effort to battle these issues, various health departments throughout the U.S. help educate women about the causes of infant mortality and ways to prevent this disparity. Education about nutrition, how smoking, drugs, and alcohol affects a fetus, and education about the importance of prenatal health care are incorporated in the teaching. In Vernon County in Nevada Missouri, there is a high population of women that smoke prenatally. The Vernon County Health Department sees a lot of these women. Most of them are poverty stricken and lack the health literacy to stop smoking. The Vernon County Health Department educates the women about the harms of prenatal smoking. The rate of prenatal smoking has declined in Vernon County in the past two years as evidenced by statistical analysis from the community health assessment found on www.health.mo.gov. Another issue that affects children in the U.S. is childhood obesity. According to the CDC (2012), childhood obesity in the U.S. has more than tripled in the past thirty years and the percentage of children from ages 6 to 11 years in the United States who were obese increased from 7% in 1980 to almost 20% in 2008. The percentage of adolescents from ages 12 to 19 years who were obese increased from 5% to 18% over the same period. In 2008, more than one third of children and adolescents were overweight or obese (Child health, 2012). This is a large population of obese children. This not only affects children in the U.S. but also affects adults. Obesity increases the risk for major health problems such as cardiovascular disease, diabetes, stroke, cancer and osteoarthritis (Child health, 2012). The U.S. government has addressed this issue by placing regulations on the type of foods served in schools. Health

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS

departments also hold health fairs to educate the population about the effects of obesity and how to prevent it. Childhood obesity is not the only nutritional problem that Americans face. According to the U.S. Census Bureau (2012), the poverty rate of Americans in 2010 was 15.1% and the number of Americans in poverty was 46.2 million. Poverty puts individuals at risk for nutritional and health disparities. A program developed by the United States Department of Agriculture in an effort to help control the nutritional deficit of women and children is the Women, Infants, and Children (WIC) program. WIC is a special supplemental nutrition program which provides services to pregnant women, new mothers, infants, and children up to their fifth birthday based on nutritional risk and income eligibility (Women, infants, and children, 2012). The primary services provided are health screening, risk assessment, nutrition education and counseling, breastfeeding promotion, and referrals to health care. Supplemental food is provided at no cost to participants. A big topic covered in the WIC program is breastfeeding promotion. Infants are generally healthier if they are breastfed. Past experience shows that pregnant women who participate in the WIC program have fewer low birth weight babies, experience fewer infant deaths, see a doctor earlier in pregnancy and eat healthier (Women, infants, and children, 2012). Epidemiology is addressed in health departments. Certain diseases in the U.S. are required to be reported to the health departments such as tuberculosis, influenza, measles, pertussis, polio, rubella, shigellosis, and many other diseases. In an effort to control certain diseases, the health department provides vaccinations to the public. In the U.S., children are supposed to have certain vaccinations before attending school. The Health Department provides vaccinations such as diphtheria, pertussis, tetanus, varicella, polio, hepatitis A and B, measles,

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS

mumps, rubella, flu vaccine, Haemophilus influenza type b, and the pneumonia vaccine. Today, children in the United States routinely get vaccines that protect them from more than a dozen diseases such as measles, polio and tetanus. Most of these diseases are now at their lowest levels in history, thanks to years of immunization (Vaccines, 2012). Children must be vaccinated before they are allowed to attend school. The Centers for Disease Control and Prevention publishes a schedule for childhood vaccines. In an effort to control communicable diseases spread by contaminated foods, the health inspector inspects restaurants and other public places that may serve food. The community health departments house the health inspector. Adolescents to Young Adulthood During adolescents to young adulthood, many kids do not think about their health, nor the consequences of their actions. They are more concerned with having fun, playing sports, going out, or the newest fashion and perhaps neglecting one of the most important things in life, their self. With the WHOs definition of health during this time frame, one can look at the three main factors and determine them healthy or unhealthy; these factors are physical, mental, and social health. As our cultural has adapted and changed, we have begun to look at these factors in a different light. Physical health has adapted into a more relaxed outlook, which has unfortunately seen a rise in major diseases. Such as, early heart conditions, respiratory issues, and diabetes. Mental health, still very young in the ways of diagnoses and treatment has an increased aspect in this age group. Kids these days seem to be growing and maturing faster than previous generations, and perhaps for the worst. A study performed in 2009 showed that eight percent of the population ages 12 to 17 had a major depressive episode. Of those population ages 72 percent reported that depression caused severe problems in at least one major role domain (Adolescent depression, 2011). Depression and depressive episodes can

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS unfortunately lead to a dependency of drugs, or alcohol. Social health has, sadly, been a factor

generating a lot of attention lately. While bullying has been around since the beginning of time, it has seemed to show an increase lately; perhaps leading to an increase in suicide of this age group. At the Jasper County Health Department, of the patients in this area of life, many of them come to the Health Department for sexually transmitted disease (STD) testing. Through the government, the Jasper County Health Department offers free STD testing, with the only payment being antibiotics, if needed. This testing includes a blood draw for HIV and Syphilis, and swab of the urethral opening for men and vaginal tract for women to check for gonorrhea and Chlamydia. STDs and STIs are becoming more prevalent in this age demographic. A study performed by the Centers for Disease Control (CDC) in 2009 showed some startling results for high school aged kids. 34% of students had had sexual intercourse during the previous three months, and, of these, 39% did not use a condom the last time they had sex, also 77% did not use birth control pills or the Depo-Provera to prevent pregnancy. These sexual risk behaviors placed adolescents at risk for HIV infection or other STDs, and unintended pregnancy. An estimated 8,300 young people aged 13-24 years in the 40 states that reported to the CDC had an HIV infection in 2009. Nearly half of the 19 million new STDs each year are among young people aged 15-24 years. More than 400,000 teen girls aged 15-19 gave birth in 2009 (Sexual behaviors, adolescent, 2011). Of the patients that come in, many of them are there for the fear of possibly having a sexually transmitted infection (STI). When the patients come in, they are asked a series of questions regarding their sexual life. These questions pose at risk factors for the patient. With

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS each yes answer, their risk for possibly contracting a STI goes up. Many of the patients that

come into the health department are there for the first time and unsure of the process or might be in denial this is happening. When they first arrive into the room, they are given pamphlets regarding STD/STIs. They are given a chance to read the information, the nurse then asks the patients if they any questions regarding the information in the pamphlets. Giving out information can be a great factor in the prevention of STDs. When patients come into the health department, they are given a pamphlet regarding STD/STIs. They are also told the importance of practicing safe sex, not just for them, but for their partner, too. A lot of times, people in age demographic are young and naive. They might not know any better or have neglected to learn. This is a very trying age demographic and giving the information and reiterating it might be just what the person needs to change their ways. Middle-Aged Adults When considering middle-aged adults there are many things that contribute to their health. These things could be their job, school, children, or other factors. One of the main problems seen at the Health Department seems to be obesity. Obesity is defined as having a Body Mass Index of 30 or higher. According to University of Maryland Medical Center, obesity is on the rise with a total of 35.1% of adults being obese (Ehrlich, 2010). Obesity puts a person at risk for several diseases such as, heart disease, diabetes, cancer, stroke, osteoarthritis, high blood pressure, gallbladder disease, and respiratory disorders (Ehrlich, 2010). Of these diseases diabetes, high blood pressure, and heart disease seem to be the most prevalent of those patients at the Health Department. Diabetes is a disease where there is too much glucose in the blood. One of the tests for this is HbA1C, or the glycated hemoglobin test (Mayo Clinic Staff, 2012). The levels for this test

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS should normally be less than 6.5%. Diagnosis occurs with two tests with a value greater than 6.5% (Mayo Clinic Staff, 2012). The other day at the health department there was a woman whose result was 13.1%, which is very high. This was a patient who has already been diagnosed with diabetes and on medication. One thing that seems to be common is noncompliance, and from the results it is shown that this patient is not being compliant. High blood pressure is something that is not addressed a lot at Health Department, but if there is a high blood pressure reading the blood pressure is retaken, and the patient is referred to their primary care physician. People come to the Health Department to be tested for sexually transmitted diseases in this age group. This is a topic that requires a lot of education; and if any results are positive they are also referred to their primary care physician. There are programs that are offered through the health department. WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation is one of the prevention programs offered, this is through the Show-Me Healthy Women program. This program allows for annual exams testing blood pressure, total cholesterol, HDL, blood glucose, and height and weight to show the current body mass index ("Wisewomen," 2012). The Health Department has an immunization day each month, which is showing prevention. The Health Department is where many people go to have their blood drawn for different labs. The Registered Nurse does a lot of education with patients along with giving handouts and supplemental information when needed. Older Adults

Older adults are a growing population. In 1900, only 4% of Americans were over the age of 65 (Stanhope & Lancaster, 2008). In 2002, statistics showed close to a 10% increase in older adults as they now account for 12.4% of the population. Along with middle-aged adults, older

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS adults have several factors that contribute to their health (Stanhope & Lancaster, 2008). Agerelated changes are taking place during these times, which increases the risk for disease. The

main diseases that are seen in older adults are the same diseases that are prevalent in middle aged adults. The biggest one of these seen at the Health Department seems to be again, obesity. Patients with lung cancer and congestive heart failure are seen at the health department. There was also a patient seen in the past few weeks who had had shingles. Lung cancer has a number one risk factor of smoking (Chen, 2011). The longer a person and how much a person smokes have effects on when lung cancer arises. Majority of those who have lung cancer have smoked at some point in time, but lung cancer can also occur in people who have never smoked before (Chen, 2011). Shingles is a communicable disease which can be prevented through the varicella vaccine (Varicella-zoster virus, 2012). Shingles occurs after having chicken pox, but the chicken pox would be inactive for time before shingles develop. With shingles there is numbness and a skin rash with blisters (Varicella-zoster virus, 2012). There are programs through the health department that are offered for older adults. The Child and Adult Care Food Program (CACFP) is one of these programs. It is offered through certain adult day cares, adults must be 60 years of age or older ("Child and adult," 2012). The requirements for this program include well-balanced meals served and healthy eating habits are taught ("Child and adult," 2012). Another resource is the Live Well Message Alliance. Organizations work together to help people with chronic diseases including cardiovascular disease, diabetes and cancer. Conclusion Many health promotion and health maintenance programs are offered at various Health Departments in an effort to keep the U.S. population throughout the lifespan healthy. The biggest

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS 10 issues plaguing the U.S. population are cardiovascular disease, diabetes, and obesity. These conditions are also co-morbid conditions. If can decrease the rate of obesity, we can possibly decrease the incidence of cardiovascular disease and diabetes. Food care programs are offered in the U.S. for those that are in poverty and are unable to effectively provide for their families, and for those who are physically unable to prepare their food due to aging changes. The U.S. provides many vaccinations to the public in an effort to decrease epidemiology. STIs tend to be a big issue for the adolescent population in various areas of the United States. In an effort to decrease this issue, health departments are providing pamphlets and education to this population. U.S. Health Departments work to promote and maintain health and to prevent illness.

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS 11 References Adolescent depression. (2011). Retrieved March 27, 2012 from http://www.childstats.gov/americaschildren/health4.asp Child health. (2012). Retrieved from March 28, 2012 from http://www.cdc.gov/nchs/fastats/children.htm Chen, Y. (2011). Lung cancer. Retrieved March 29, 2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004529/ Child and adult care food programs. (2012). Retrieved March 29, 2012 from http://health.mo.gov/living/wellness/nutrition/foodprograms/cacfp/index.php Definition of health. (2012). Retrieved March 29, 2012 from https://apps.who.int/aboutwho/en/definition.html Diabetes. (2012). Retrieved March 29, 2012 from http://www.mayoclinic.com/health/diabetes/DS01121/DSECTION=tests-and-diagnosis Ehrlich, S. (2010). Obesity. Retrieved March 28, 2012 from http://www.umm.edu/altmed/articles/obesity-000117.htm#ixzz1qY6FOO1o Health department. (2012). Retrieved March 29, 2012 from http://www.merriamwebster.com/medical/health%20department Income, poverty and health insurance in the United States: 2010. (2012). Retrieved March 28, 2012 from http://www.census.gov/hhes/www/poverty/data/incpovhlth/2010/figure4.pdf Live like your life depends on it. (2012). Retrieved March 29, 2012 from http://health.mo.gov/living/wellness/lifedependsonit/index.php Sexual behaviors, adolescent and school health. (2011). Retrieved March 28, 2012 from http://www.cdc.gov/healthyyouth/sexualbehaviors/index.htm

Running head: COMMUNITY HEALTH ISSUES FACED BY HEALTH DEPARTMENTS 12 Stanhope, M., & Lancaster, J. (2008). Public health nursing: Population-centered health care in the community. (7 ed.). Philadelphia, PA: Elsevier. Vaccines. (2012). Retrieved March 29, 2012 from http://www.who.int/ith/vaccines/en/ Varicella-zoster virus. (2012). Retrieved March 29, 2012 from http://health.mo.gov/living/healthcondiseases/communicable/chickenpox.php Wisewomen. (2012). Retrieved March 29, 2012 from http://health.mo.gov/living/healthcondiseases/chronic/wisewoman/index.php Women, infants, and children. (2012). Retrieved March 28, 2012 from http://www.fns.usda.gov/wic/